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Perthe's disease (Epidemiology (M>F, Age 5-10y, Can be bilateral,…
Perthe's disease
Epidemiology
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Can be bilateral, but
rarely simaultaneously
Diagnosis
Examination
Musculoskeletal exam
Hip: antalgic gait (early), Trendelenbery +ve (late),
reduced ROM in all planes, pain
Spine and knee exam: nil
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Investigations
Bedside
Obs (nil)
Measurements (weight, height, BMI)
Imaging
Pelvic X-ray (PA, frogleg): early signs (joint space widening, reduced femoral head size, patchy opacity); late signs
(collapse and deformity of femoral head,new bone formation)
Bone scan, MRI scan (if X-rays unclear)
Bloods
FBC, CRP, U+E, LFT,
blood cultures (all nil)
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History
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POH
Scans, bloods, gestation, delivery,
weight (LBW), complications
PC/HPC
Insidious onset hip/knee pain, limp,
apyrexial, otherwise well
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SH
Living arrangements,
school/nursery, activity levels
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Pathophysiology
Defect
Idiopathic/unknown trigger
Avascular necrosis of the capital femoral epiphyses of femoral head due to interrupted blood supply
Mechanism
Self healing with revascularisation and reossification over 1.5-3y
Bone remodelling distorts the epiphyses with abnormal ossification
Clinical
presentation
Pain
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Site
Hip or referred to knee,
uni or bilateral
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Associated symptoms
Limp, reduced ROM
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